Friday, May 31, 2013

"I don't want to take a pill just to take it. Because I'll be "taking it" taking it, when I'm not sure I need to take it. But if I have to "take it" take it, then I'll have to take it and will take it. But only if I really have to "take it" take it.

Thursday, May 30, 2013

Times are tough for doctors these days. No one gives a shit, so I'm not elaborating further.

But even big institutions are affected. Take, for example, the venerable MD Anderson Cancer Center in Texas. This giant of oncology has recently been having financial issues, so much so that its president, Ronald DePinho, sent out this e-mail to employees 2 weeks ago:

"For most of fiscal year 2013 our operating expense has exceeded our operating revenue - meaning that we've spent more than we've made from providing patient care services."

He went on to say that because of this shortfall MD Anderson is suspending merit raises and slowing its hiring rate. This is what they call "austerity measures."

At the same time Dr. DePinho is preaching financial restraint for his cash-strapped institution, he's used $1.5 million of its capital funds (which come from investment income, donations, and patient revenue) to build a 25,000 square-foot (2,322 square meter) office suite for Dr. Lynda Chin at the institution.

Who just happens to be his wife.

Really. I am not making this up.

Dr. Chin is the scientific director of MD Anderson's Institute for Applied Cancer Science. How this justifies her having an office suite that is 10 x larger than the average American home is beyond me. According to the institute it's to "provide an appropriate meeting space with high-level industry decision makers and support a new suite in computational biology." Translation: By using a lot of syllables we're hoping you'll ignore what's really going on here.

And no, I have no idea what "computational biology" is. Maybe that's why my entire office is 1,250 square feet, including the john.

According to an itemized expense report (obtained by The Cancer Letter under the Texas Public Information Act) this ginormous office has $28,000 worth of chairs, sofas, and tables. They also spent $210,000 on fancy translucent glass walls, which required them to get a special permit from the University of Texas. By comparison, the Grumpy Neurological Emporium has used furniture (valued at $948 total), and plain old painted drywall.

I'm going to close with another quote from Dr. DePinho, found in the same e-mail I quoted earlier about the austerity measures MD Anderson will have to take to survive:

"If we don't make changes now, we potentially will find ourselves in a crisis that will force us to take drastic measures that could hurt our ability to meet our mission... [all will] have to share sacrifices."

Wednesday, May 29, 2013

If you read the popular stuff, you'd think there were only 3 major shipwrecks of the 20th century: Titanic, Lusitania, and Andrea Doria.Obviously, there are many more, even if you exclude 2 worldwide conflicts in the last 100 years. The worst peacetime shipwreck in history, the Dona Paz (Philippines), took 4,375 lives as recently as 1987. And I bet you've never heard of it.

Trans-Atlantic crossings have always been critical to both sides of the Atlantic (look at the chaos caused by the recent Icelandic volcanic eruption). Although the giant liners of Cunard and White Star are best remembered, they were by no means alone. Ships were constantly coming and going, carrying passengers and freight, both ways across The Pond.

Although less glamorous than the liners that sailed in & out of New York, there were many busy ships that called on the Canadian ports. One was the Empress of Ireland, which in 1914 was serving the Quebec City to Liverpool route.

Early this morning, 96 years ago, the Empress was outbound from Canada. She was heading northeast on the St. Lawrence River. It was 2:00 a.m., and most of the passengers were sleeping.

In a thick fog, the Norwegian coal-carrier Storstad struck the Empress on the starboard side. The damage was extensive. There was only limited time to sound an alarm, and electricity failed quickly, plunging the ship into darkness. The Empress was gone in 14 minutes.

The survivors were picked up by the few lifeboats that had been launched, and were carried back and forth to the Storstad, which had stayed afloat. Captain Henry Kendall, who was thrown into the water as the ship rolled over, supervised the rescue efforts and likely saved many lives by organizing the lifeboats.

All together the Empress took 1,024 people with her. It remains the deadliest maritime disaster in Canadian history. In spite of this, the ship is mostly forgotten today. The St. Lawrence Seaway is a very busy channel. Hundreds of ships steam over the Empress every day, very few knowing of the tragedy beneath them.

The Salvation Army remembers. A large contingent of members (167) were lost on the ship, traveling to a conference in London. There is a monument to them at Mount Pleasant Cemetery, in Toronto.

The Empress of Ireland is in 130 feet of water, well within the range of scuba equipment, but the currents and poor visibility limit diving

Monday, May 27, 2013

John Cromwell was born in Illinois, but his heart took him from the midwest to the ocean. He graduated from Annapolis in 1924.

His initial sea service was on the battleship Maryland, but his abilities led to him being picked for the fledgling American submarine force. He served aboard, and commanded, some of the United States Navy's first large submarines.

After several tours at sea, Cromwell was selected for further training in the complex diesel engines that were critical to submarines of the pre-nuclear era. He rose through the ranks, eventually becoming a division commander.

WWII found now-Captain Cromwell in the Pacific, commanding submarine divisions 203, 43, and 44. His flagship was the U.S.S. Sculpin.

In November, 1943 Sculpin (commanded by Lt. Cmdr. Fred Connaway) put to sea with orders to rendezvous with the submarines Searaven and Spearfish to attack Japanese shipping. Upon arrival Cromwell would take command of the group.

The Americans were preparing to invade Tarawa island later that month. It would be a critical (and bloody) fight to wrest control of the central Pacific from Japanese forces. Cromwell was aware of the operation's details, and was also familiar with the top-secret American ability to read Japanese military codes.

On November 18, 1943, while en route to the rendezvous, Sculpin was preparing to attack a Japanese convoy. A damaged depth gauge, however, caused her to surface rather than go to periscope depth, and she came up directly in front of the Japanese destroyer Yamagumo. Although Connaway quickly dived again, it was too late. Yamagumo pounded Sculpin with a series of depth charges, causing severe damage.

With no way to escape, and more destroyers coming, Connaway decided to surface again and try to fight it out. The destroyer was ready. As the Sculpin came up, Yamagumo's first salvo killed her entire bridge crew (including Connaway) and those running to man the weapons.

Captain Cromwell realized the secrets he knew could seriously jeopardize the American war effort. The Japanese couldn't be allowed to learn the invasion plans for Tarawa, or that the Americans had broken their codes. While he wouldn't voluntarily talk, there was no guaranteeing he might not break under torture or the influence of interrogation drugs.

He therefore decided to stay with Sculpin forever. He helped the crew abandon her, but made no move to leave himself. He was last seen standing in the control room, watching it fill with water.

Thursday, May 23, 2013

Mrs. Mom: "I'm worried about my son. I think he drinks too much, and I know it's bad for him."

Dr. Grumpy: "I'm sorry to hear that."

Mrs. Mom: "The only person he'll listen to is Dr. Intern, but he refuses to go back to see him about this."

Dr. Grumpy: "How are you..."

Mrs. Mom: "Anyway, here's my son's phone number. Can you please call him tonight, and pretend to be Dr. Intern to talk to him about the drinking? The doctor is from Germany, so you'll have to fake an accent, and..."

Tuesday, May 21, 2013

A friend recently suggested I try Cleverbot. She figured that since my life has reached a point where I routinely talk to Siri, I might as well converse with other computers (and to think I started out chatting up Eliza on a TRS-80). After all, Cleverbot even has a picture of a brain on the site, endearing it to my profession.

I'm well aware that querying these things is like using a Magic 8-Ball. But, while seeing a patient yesterday, I decided to ask it a question for the hell of it.

Friday, May 17, 2013

In case you live under a rock, the BEST news story of the week didn't involve murder (unless you consider a reputation), terrorist attacks (unless you consider an undercooked pizza as such), or hurricanes (except for one named Amy).

It involved the bizarre online meltdown of a restaurant in Scottsdale, Arizona called Amy's Baking Company. This place was featured on Gordon Ramsay's cooking show, and became the first place he was ever entirely unable to help, and actually walked out on. If that was the whole story it would be forgotten by now.

What made it much better than anything else, though, were the antics of the place's owners as we watched them steal tips, abuse costumers (and not in a semi-lovable Edsel Ford Fong sort of way, either), and pass off pasta from a grocery store as homemade. If you haven't seen it, be sure to watch it on Kitchen Nightmares. You won't be disappointed.

But what made it a moment for the ages was their bizarre online complete meltdown (well chronicled elsewhere) with them throwing obscenities, claiming the high ground of a deity supporting them, and using ALL CAPS randomly. Then they claimed a hacker had done it all, and not them (although they've done similar things before).

Now, I know nothing about restaurants, beyond which ones have banned my kids from ever coming back. But I have made misuse of the word "artisan" and its derivatives a sort of crusade.

So, looking at their site I noticed the inevitable word "artisan" on it (oddly capitalized, along with "Gourmet" and "Pizzas").

In the same paragraph it noted they serve "house made Artesian Pastas."

Look: "artesian" means an aquifer or spring in the ground, which provides water. It has nothing to do with "artisan." Water can never be artisanal, but it is often artesian. Capisce?

So, Amy, unless you've found some sort of natural spring that produces a steady stream of pasta (sort of like the famous spaghetti farms), I want to make these points:

1. Unless it came flowing out of the ground, it's NOT artesian.

2. If you made it yourself, by hand, you can call it artisanal.

3 If you bought it from the grocery store and are reselling it as your own, it's not "house made," "artisanal," or "artesian."

4. You should also use a comma. To the best of my knowledge there is no such thing as "Artesian Pastas fine wines."

Mrs. Batter: "I feel awful. My husband and I were planning on coming to it, but then he got tickets to last night's baseball game from his friend Ed, so we went to that instead. You remember Ed? I think he sees you for his foot problem. And now I can't sleep because I feel so awful about not going to your talk, because I knew you'd be offended that I wasn't there."

Dr. Grumpy: "It's okay Mrs. Batter. I'm not offended. The local Stroke Association chapter had announced the talk, so there was a decent turn-out."

Tuesday, May 14, 2013

Mr. Stats: "Absolutely!" (whips out iPad) "As you can see from this graph, I"m sleeping 22.8% more than I was before trying Dozaway, and here... (swipe) it shows how I'm falling asleep 17.3% percent faster, and on this next screen... (swipe)"

Monday, May 13, 2013

Snowball recently got some shots and had a tooth pulled, so spent a few hours at the veterinarian. That evening I noticed they had our phone number wrong on the bill, so called the next morning to correct it.

Phone Girl: "Local Animal Hospital, I..."

Dr. Grumpy: "Hi, this is Ibee Grumpy, and..."

Phone Girl: "I'd like to wish you a very happy National Hug-Your-Cat-Day this month!"

Dr. Grumpy: "Okay, I picked up Snowball yesterday, and realized you have our contact info wrong."

Phone Girl: "Did you know National Hug-Your-Cat-Day is this month? Cats do so many wonderful things for us, that it's important to take care of their heath, too!"

Dr. Grumpy: "I don't have a cat. I'm just calling about an error..."

Phone Girl: "Well, now would be the perfect time to consider getting one! We have 3 cats looking for loving homes here, and several animal shelters we're working with for National Hug-Your-Cat-Day are running offers to help you enjoy them!"

Dr. Grumpy: "Look, I don't want a cat. I just need to give you our correct phone number."

Phone Girl: "Cats are wonderful companions! I'm sure if you came over and met some of the adorable ones available for National Hug-Your-Cat-Day you would..."

(loads up car, drives SLOWLY to school and back, with kids peering out the windows and other drivers honking and giving me the bird for blocking traffic, while I randomly slam on the brakes any time a kid sees a leaf, or crushed paper cup, or piece of dog shit that vaguely resembles a school ID and screams "THERE IT IS!!!")

I finally gave up and drove back home.

Dr. Grumpy: "Marie, it doesn't appear to be out there anywhere."

Marie: "It has to be! It was while we were walking home today that I noticed it was missing!"

Monday, May 6, 2013

Mr. Sutton was unusually hopeful that if he called 911 enough, the police would deliver marijuana and munchies to his home. When they showed up and failed to bring either, he consoled himself by eating the police car instead.

Second, we have the remarkably organized Carolyn Murray of Pennsylvania.

This fine lady was involved in a car accident. While providing her insurance forms to officers she handed them a shopping and to do list, which included such items as "potato salad," "Xanax," and "cocaine." It also had a helpful reminder to "get high."

Dr. Grumpy: "What's wrong? You've been on Zuclox for almost 10 years without any problems."

Mr. Miyagi: "It's affecting my balance."

Dr. Grumpy: "Why do you say that?"

Mr. Miyagi: "I fell this weekend."

Dr. Grumpy: "What happened?"

Mr. Miyagi: "I was at the senior citizens dance, trying to meet some ladies. You see, back in 1946 I was stationed in Japan, and learned karate there. I was really good at it, too, and won a few tournaments. I haven't done it since I left the army though. Anyway, at the dance, some of the ladies and I were having drinks at the bar, and they were talking about those karate films, so I decided to show them my moves. I lost my balance and fell on my butt, and all those ladies started laughing at me. One of them laughed so hard her friend had to bring in her oxygen tank."

Dr. Grumpy: "I'm not sure Zuclox is why you fell."

Mr. Miyagi: "I looked it up. Balance problems are in the side effects."

Dr. Grumpy: "Yes, but you never had them with it before."

Mr. Miyagi: "Look, just tell me how to stop it. The next dance is in 2 weeks."

Wednesday, May 1, 2013

A few months back I poked fun at Fycompa, a new epilepsy drug with an interesting side effect profile. Little did I realize I'd have the chance to do it again (different drug this time) so soon.

Like neurologists everywhere, I was surprised to hear the news Monday about a newly reported side-effect concerning the epilepsy drug Potiga.

Namely, that it makes people blue.

I'm not talking depression here, either.

Let's look at the official FDA announcement:

"FDA is warning the public that the anti-seizure medication Potiga (Ezogabine) can cause blue skin discoloration... (and) does not currently know if these changes are reversible.

The skin discoloration in the reported cases appeared as blue pigmentation, predominantly on or around the lips or in the nail beds of the fingers or toes, but more widespread involvement of the face and legs has also been reported. Scleral and conjunctival discoloration, on the white of the eye and inside eyelids, has been observed as well."

Now, with that said, I want to remind you that if you look at the side effects of ANY drug, you'll find scary shit on all of them. I'm sure I'll put patients on Potiga, and most will likely do fine. But that doesn't mean we can't have some fun with it.

For one thing, they don't even tell you what shade of blue. There are 45 of them. Some people if given the choice, would like a nice turquoise, while others would prefer royal blue. Hopefully further research will shed light on this important topic.

The interesting part is this: Let's say a patient had a choice between this drug and one with a "YOU COULD DIE FROM THIS!!!" black box warning. Felbatol, for example, while very effective for seizures, has the potential to cause TWO (not one, but TWO) great ways to die: severe liver failure and/or destruction of your bone marrow.

Yet, human nature is such that most people would prefer Felbatol, figuring the risk of death is preferable to that of turning blue. After all, death generally isn't socially embarrassing. We ALL die. But blue skin? That's just not fashionable.

Unfortunately, GSK (the drug's manufacturer) is likely going to see this as a drawback to Potiga. They'll tell their sales reps to minimize it and move on to something else. Or mumble "and they might turn blue" hurriedly under their breath.

The truth is they should turn it around, and make it a strength of their spiel. The best way to do this, as I see it, would be to go after some commercial tie-ins.

I've compiled a few modest examples:

Live theater:

Potiga is a proud sponsor of tonight's appearance by:

Blue Man Group

1960's psychedelic movies:

United Artists

To treat seizures, All You Need is Love. And Potiga.

1970's psychedelic movies:

Paramount Pictures

"Violet Beauregarde has been seizure free on Potiga. Next month she'll be endorsing juicers, too."

2000's movies:

Twentieth Century Fox

Potiga for epilepsy: It's out of this world!

2000's remakes of 1970's psychedelic movies:

Warner Brothers

Potiga is now available as chewing gum for your patients who won't swallow pills. Violet Beauregarde set a world record with it!

Music acts:

Atlantic Records

"We're both proud to be on Potiga. Otherwise we wouldn't be able to drive as safely as we do."

Historical tie-ins:

Bunker Hill: Would history be different if British officers had given their men Potiga beforehand?

Using it as an excuse...

ABC television

"No, officer, he wasn't into that sort of thing. He's that color from taking Potiga."

Currently Potiga is only approved for ages 18 and up. But maybe it will work in kids. If that happens, GSK is fortunate to have a wide range of endorsers to choose from!

Dupuis Cartoons

Shaky Smurf, Seizey Smurf, Ictal Smurf, and Aurette are all doing great on Potiga! If it's right for Papa Smurf, isn't it right for your child?

And, of course, who could forget

Sesame Street

New Potiga powder! You can sprinkle it on all your child's favorite foods! EVEN COOKIES!!!

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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Dr. Grumpy is for hire! Need an article written (humorous, medical, or otherwise) or want to commission a genuine Grumpy piece for your newspaper/magazine/toilet paper roll? Contact me to discuss subjects. You can reach me at the email address below.

Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.